Periodontal disease encompasses a group of different disorders which affect the gums or supporting structures of the teeth. The general epidemiology of plague associated periodontal disease typically begins with the formation of supragingival microbial plaque which, if left untreated, subsequently invades the normally closed space between the free gingiva and the tooth surface. If left unremoved, such subgingival plaque gives rise to the formation of harden calculi and areas of erosion on the subgingival surfaces of the tooth (i.e., the subgingival enamel and root surfaces). Resultant inflammation of the surrounding tissues and recession of the surrounding connective tissue and bone then occurs. Such inflammation and recession of the periodontia results in the formation of a gap or "periodontal pocket" between the gingival tissue and the adjacent tooth surface. The gradual loss of ligamentous attachment and surrounding alveolar bone mass in periodontal disease often results in loss of the affected tooth, unless effective treatment is administered to halt the progression of the disease.
Clinically, plaque associated periodontal disease may be treated by either a surgical or nonsurgical approach. The surgical approach to the treatment of plaque associated periodontal disease typically involves the performance of one or more surgical procedures whereby the gingival tissue is excised and the underlying tooth surfaces (e.g., subgingival enamel and a portion of the root) are visually examined and subjected to scaling and root planning under direct visualization. Although the surgical approach to the treatment of plaque associated periodontal disease is often highly effective, such surgical approach is also associated with significant expense and a significant degree of patient discomfort.
The nonsurgical approach to the treatment of plaque associated periodontal disease typically involves procedures known as subgingival scaling and root planing. Some chemical formulations for dissolving and/or removing subgingival plaque and/or calculus are also known. Subgingival scaling and root planing procedures are typically accomplished by inserting a hand instrument, an ultrasonic or sonic cleaning device and/or a rotating instrument into the periodontal pocket (PP), without cutting or excising the gingiva, for the purpose of scraping plaque or dental calculus from the subgingival tooth surfaces. Typically, such instruments are comprised of an elongate handle portion having a working part or treatment head or tip, the latter being operative to remove the target plaque and/or calculus. The ultimate effectiveness of such subgingival scaling and root planing procedures, or chemical plaque/calculus removal methods, is dependent upon the completeness with which removal of plaque or calculi has been effected by such procedures.
Because the surrounding gingiva remain intact, the operator is unable to directly view the subgingival tooth surfaces when carrying out such subgingival plaque and calculus removal procedures. The inability to visualize the subgingival tooth surfaces make it virtually impossible for the aperture to ascertain whether all of the subgingival plaque or calculus has been effectively removed. Failure to completely remove all subgingival deposits of plaque or dental calculus may result in progression of the periodontal disease. Such progression of the disease often necessitates abandonment of the nonsurgical treatment approach in favor or the more costly and painful surgical approach.
In an attempt to address the need for new devices and techniques whereby the subgingival tooth surface may be endoscopically viewed to permit visual assessment and/or guidance of subgingival plaque/calculus removal procedures without the need for surgical cutting or excision of the gums, there is disclosed in U.S. Pat. Nos. 5,230,621 and 5,328,365 entitled, respectively, Endoscopic Method And Device For Subgingival Dental Procedures And System; and Method For Endoscopic Subqingival Dental Procedures (both to Jacoby), endoscopic viewing devices which are insertable into the subgingival sulcus periodontal pocket to enable the operator to view the subgingival tissue and/or tooth surfaces, without the need for surgical incision or cutting of the gingiva, the teachings of which are expressly incorporated herein by reference. Specifically, there is provided an optical head formed upon the dental hand instrument that is aimed or positioned toward the leading edge of the working part or blade of such hand instrument to permit the operator to endoscopically view the plaque and/or calculus removal being effected by the leading edge of the working part or blade of the instrument. Each of the aforementioned Patents further disclose dental instrumentation optionally incorporating as a part thereof a dilator projection that is sized and configured to spread and hold the gingiva away from the tooth surface over a region or area of approximately several square centimeters ahead of the working part or blade of a hand instrument used for scaling and root planing.
Notwithstanding the general effectiveness of those devices disclosed in U.S. Pat. Nos. 5,230,621 and 5,328,365, such prior art devices suffer from significant drawbacks. In this regard, such systems produce a limited field of vision and depth of view based upon the proximity of the optical head relative the dilator projection and/or working part or blade of the instrument. Specifically, the visual image generated by the optical head provides the dentist or hygienist with a substantially limited view of the surface of the tooth sought to be visualized. In fact, due to the orientation of the optical head pursuant to the teachings of the aforementioned patents, the working part of the instrument becomes the dominant object viewed thereby, often consuming virtually all of the field of vision. As a result, the dentist or hygienist is therefore limited in his or her ability to directly visualize the subgingival tooth surface sought to be endoscopically viewed.
Accordingly, there is a substantial need in the art for improved devices and techniques whereby the subgingival tooth surfaces may be endoscopically viewed to a much greater extent than prior art devices to thus permit visual assessment and/or guidance of subgingival plaque/calculus removal via non-surgical procedures.